Why 11-beta-hydroxylase deficiency causes hypertension even though it results in reduced aldosterone synthesis:

" because of overproduction of cortisol precursors that are, or are metabolized to, mineralocorticoid agonists." Source

• Cutaneous T cell lymphoma - usually limited to the skin. Looks like pityriasys versicolor.
• benign course
• Phototherapy is a treatment.
• Looks eczematous or like psoriasis; often initially on buttocks.

[!INFO] Mnemonics
REDMAN or SCALP-ID
REDMAN : Eczema / psoriasis, Drugs, Malignancy (mycosis fungoides, CTCL, Autoimmune, No identifiable cause)

SCALP-ID

• Normally, the kidney deactivates cortisol via the enzyme 11-beta-dehydrogenase isozyme 2 to inactive cortisone, thus 'protecting' it's mineralocorticoid receptors from the effects of cortisol. Source
• In ectopic ACTH mediated Cushing's syndrome, this inactivation is overwhelmed and cortisol acts on the aldosterone receptors -> producing hypokalemia.
• #2021GM-JUL/Q16 Deficiency of 11-beta-dehydrogenase occurs in "apparent mineralocorticoid excess".
  #2021GM-JUL/Q16

Apparent mineralocorticoid excess syndrome

[!TIP] Mnemonic: Similar to Conn's syndrome but with low renin and aldosterone.

Caused by deficiency of 11-beta-dehydrogenase.
Features:

• Hypokalemia

• Metabolic alkalosis

• Low plasma renin activity

• Low plasma aldosterone levels

• Chronic liquorice (licorice) ingestion causes a similar picture. It inhibits 11-beta-dehydrogenase.

Streptococci

Comparison of some medically important streptococci

[!TIP] Common terminology

• Pyogenes = GABS, Group B strep - Agalatiae; Pneumococcus = Strep pneumonia.

• Scarlet fever (not a late complication but a manifestation of infection)

• [[Nephrology miscellaneous#Membranoproliferative glomerulonephritis|Membranoproliferative(aka mesangioproliferative,aka mesangiocapillary) glomerulonephritis]]

[!INFO] Membranoproliferative and Mesangioproliferative are described under "acute nephritic syndromes" in Harrison's
This probably means they present more often as nephritic syndromes but also can have some proteinuria.

• Type 1: subendothelial immune complex deposition (or interposition of mesangial cells in the subendothelial space) -> splitting of capillary basement membrane -> tramline appearance. (Mnemonic: "All aboard the proliferative train") -> Tramlines
  • Type 1 MPGN is commonly associated with chronic hepatitic C infection
  • Nephrotic range proteinuria is a poor prognostic marker.
  • 
  • linear intramembranous-membranous deposits
    Causes of membranoproliferative glomerulonephritis

1. Autoimmune
2. Chronic infections

There is (From Harrison's)

1. Mesangial expansion +/- mesangial hypercellularity.
2. Single contoured capillary walls
3. Mesangial immune deposits.

• Presents with varying degrees of proteinuria and commonly haematuria.
  • Isolated haematuria -> very benign course;
    proteinuria + -> increased risk of renal failure.
• Most cases are caused by [[#IgA nephropathy]].
• Falciparum malaria is a cause.

C3 glomerulopathies

• Two types: Dense deposit disease (DDD) and C3 glomerulpathy. (C3GN)
• Defined by C3 mediated glomerulonephritis with no immunoglobulin involvement.
• C3 levels are low with normal C4 levels.
• The histological patterns of C3 glomerulopathies is most commonly membranoproliferative or mesangioproliferative.

The surprising ones are highlighted; basically, myopathies tend to cause proximal symmetrical weakness; distal weakness is more likely due to nerve issues.

Paraneoplastic Dermatoses

Source

These are the Dermatoses which almost always occur with a malignancy.
| Lesion | Association | Mnemonic |
| ------------------------------------ | ----------------------------------------------------------- | ----------------------------------------------------------------------------- |
| Tripe palm (aka pachydermatoglyphia) | Lung cancer, gastric cancer | Occurs together with ANM |
| Acanthosis nigricans Maligna (ANM) | Gastric Adenocarcinoma | AN is connected to things relating to fat / stomach / tummy |
| Erythema gyratum repens | pulmonary, oesophageal, breast | Forests (wood grain appearance of rash) are the lungs of the world |
| Acquired hypertrichosis lanuginosa | colorectal, pulmonary and breast | Hairy butt |
| Bazex syndrome | Aerodigestive | |
| Acquired ichthyosis | Lymphoma | Lymfishma |
| Dermatomyositis | Ovarian Ca, Lung CA | Common in women -> ovaries.
Also, lungs
Associated with "paired organs" |
| Migratory thrombophlebitis | Pancreatic CA | Let's assume scorpion stings also case thrombosis |
| Necrolytic migratory erythema | Glucagonoma | Always carry glucose while migrating |
| Pyoderma gangrenosum | myeloproliferative disorders | pyo/myo |
| Sweet syndrome | Haematologic malignancies | Sweets raise blood sugar |
| Tylosis | Oesophageal cancer | Tie a tie around the oesophagus |
| Leser-Trelat | Gastric and colorectal | |
| Paraneoplastic pemphigus | NHL, CLL, Castleman Disease, Thymoma | |
| Pytiriasis rotunda | Hepatocellular carcinoma, gastric and oesophageal carcinoma | |
| Palmoplantar keratoderma | Oeseophageal SQC | |
| Pyoderma gangrenosum | | |
| Sweet syndrome | AML, MDS, | |
| pyoderma gangrenosum | MDS, myeloma, leukemia | |
Bazex syndrome

Pytiriasis rotunda

Necrolytic Migratory Erythema

Basis is hyperkeratosis and epidermal papillomatosis as seen on histology. Black color is not due to melanin but due to the hyperkaratosis. Source

Endocrine (Cushing's and Acromegaly)
N if for iNjected Insulin and other drugs

aka acute febrile neutrophilic dermatosis.

• Dermal neutrophilic infiltration
• Peripheral neutrophilia.
• Paraneoplastic manifestation of AML and MDS